Individual
MRS. BROCHA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 HAMASPIK WAY, MONROE, NY 10950-8451
(845) 774-8400
(845) 774-0506
Mailing address
1 HAMASPIK WAY, MONROE, NY 10950-8451
(845) 774-8400
(845) 774-0506
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
745313769
FIDELIS CARE
NY
Enumeration date
11/09/2020
Last updated
11/09/2020
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